Basic Information
| Provider Information | |||||||||
| NPI: | 1104282169 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | JOSHUA | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2321 HIGHWAY 80 E | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712039366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3186003333 | ||||||||
| FaxNumber: | 3186003334 | ||||||||
| Practice Location | |||||||||
| Address1: | 161 COMEAUX RD | ||||||||
| Address2: | |||||||||
| City: | RAYVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712697554 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3183035500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2016 | ||||||||
| LastUpdateDate: | 12/15/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 5625 | LA | N | Behavioral Health & Social Service Providers | Counselor | 101YP2500X | 4625 | LA | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.